Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 218369 | NY |
NPI | 1073516142 |
---|---|
Provider Name | Dr. Vladimir Gotlieb |
First Address | Forest Hills, NY 11375-1261 |
Second Address | Forest Hills, NY 11375-1261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
199AB1 | BCBS (01) | NY |
218369 | HIP (01) | NY |
2513705 | GHI (01) | NY |
7799489 | AETNA (01) | NY |
H97710 | (02) | NY |
P3043079 | OXFORD (01) | NY |